The Health Service Executive (HSE) has claimed that the risk of "significant public order incidents" cannot be underestimated arising from plans by 140 pharmacists no longer to provide methadone to clients from Monday.
It is putting in place a contingency plan including additional security measures and says if necessary gardaí will be asked to escort deliveries of methadone, which is a heroin substitute, to 11 centres from where emergency supplies will be distributed.
The HSE estimates that approximately 3,000 former heroin addicts who use methadone, primarily in the Dublin area, will be affected by the pharmacists' move.
In a memo to service providers, seen by The Irish Times, the executive warns of a significant clinical risk of overdose to clients who may be forced to move from a methadone maintenance programme to the use of opiates.
It is understood that 140 pharmacists, mainly in the Dublin region, have so far told the HSE that they intend to withdraw from the methadone protocol scheme.
The HSE has put in place emergency contingency arrangements, including liaising with gardaí and placing two additional security staff on duty at 11 drug treatment centres in Dublin and east Wicklow where emergency methadone supply services will be provided.
Should the pharmacists' action escalate, the HSE is also considering using hospital pharmacies and agency pharmacists and may ask staff from outside the capital to travel to Dublin to dispense.
The Irish Pharmaceutical Union (IPU) is in dispute with the HSE over cuts in the prices paid for prescription drugs. The two sides met on Thursday but no agreement was reached.
Methadone maintenance therapy is used to treat withdrawal symptoms but the synthetic substance can itself become addictive and must be administered under prescription.
Richard Collis, who runs a pharmacy in Phibsborough, Dublin, and who has informed the HSE that he will not be providing methadone from Monday, said he did so with great regret.
He supplies methadone to about 50 users, and will continue to do so for three individuals following medical requests to do so and his own analysis of their condition.
"It's an awful thing to have to do, but compared to the elderly and the infirm, methadone users are younger, more mobile and resourceful.
"So it's a measured decision taken with great regret," he said yesterday.
"Pharmacists have been utterly, totally and completely taken for granted by the HSE. We have bailed the HSE out on many occasions . . . certainly the HSE has been given ample notice . . . it should be able to meet its responsibilities."
But the heads of the country's local drug taskforces yesterday labelled the decision to stop prescribing methadone as "irresponsible and unethical".Their spokesman, David Connolly, called on the IPU to request its members to immediately call off the action."This is an outrageous decision by certain local pharmacists, who are clearly targeting some of their most vulnerable patients in their dispute with the HSE," he said.
"It is unacceptable in any circumstances that the pharmacists would use the threat of withholding essential drug treatment services from people who are struggling to defeat heroin addiction.
"The withdrawal of this service could have a negative impact on the patient's overall rehabilitation, which can be devastating for them and their families."